British journal of anaesthesia
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Logistical and ethical reasons make conducting clinical research in paediatric practice difficult, and therefore safe and efficacious advances are dependent on good preclinical research. For example, notable advances have been made in preclinical studies of pain processing that correlate well with patient data. ⋯ The potential for this toxicity must be balanced against the importance of providing adequate anaesthesia for which there can be no compromise. We review the current state of preclinical research in paediatric anaesthesia and identify areas which require further exploration in order to provide the foundations for well-conducted clinical trials.
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Randomized Controlled Trial Comparative Study
Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine.
The aim of this study was to compare the clinical effects of 'hyperbaric' bupivacaine for spinal anaesthesia with those of similar preparations of levobupivacaine and ropivacaine. ⋯ 'Hyperbaric' ropivacaine provides reliable spinal anaesthesia of shorter duration than bupivacaine or levobupivacaine, both of which are clinically indistinguishable. The recovery profile of ropivacaine may be useful where prompt mobilization is required.
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Randomized Controlled Trial Multicenter Study
Morphine pharmacokinetics and pharmacodynamics in preterm and term neonates: secondary results from the NEOPAIN trial.
Relationships between plasma morphine concentrations and neonatal responses to endotracheal tube (ETT) suctioning are unknown in preterm neonates. ⋯ A sigmoid curve describing maturation of morphine clearance is moved to the right in preterm neonates and volume of distribution is increased compared with term neonates. Morphine does not alter the neonatal response to ETT suctioning.
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Review Meta Analysis
Nefopam for the prevention of postoperative pain: quantitative systematic review.
Nefopam, a centrally acting analgesic, has been used in the surgical setting in many countries since the mid-1970s. However, clinical trials provide contflicting results for its analgesic potency. We performed a systematic search (multiple databases, bibliographies, any language, to January 2008) for randomized, placebo-controlled trials of nefopam for the prevention of postoperative pain. ⋯ The analgesic potency seems to be similar to non-steroidal anti-inflammatory drugs. However, dose responsiveness and adverse effect profile remain unclear, and the role of nefopam as part of multimodal analgesia needs to be established. Data in children are lacking.
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Randomized Controlled Trial Comparative Study
Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery.
Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence and severity of coughing during recovery in patients undergoing cervical spine surgery via an anterior approach. As a secondary aim, we also evaluated the influences of smoking and estimated residual anaesthetic agent concentrations on coughing. ⋯ The incidence of coughing after cervical spine surgery when tracheal extubation is performed according to clinical criteria is lower after propofol anaesthesia compared with sevoflurane anaesthesia. Smokers are at increased risk of coughing, independently of the type of anaesthesia maintenance. Higher residual concentrations of anaesthetic agents decrease the probability of coughing, except for smokers anaesthetized with sevoflurane.